October 2004

CCGPP begins campaign to create
understanding on ‘best practices’ initiative

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) formed in 1995 at the request of COCSA (Congress of Chiropractic State Associations) has released two in a series of articles aimed at informing stakeholders about its “best practices’ initiative.

According to the second paper, the initiative is being undertaken “to provide a common database of evidence available to the profession as a whole and to empower local chiropractic organizations to respond with a common database to challenges from payers and policy makers.”

Eugene A Lewis, DC, MPH, CCGPP chairperson, said that CCGPP (which is composed of 20 individuals drawn from multiple national chiropractic organizations) is directing the work of another group of about 60 researchers to develop best practices for the chiropractic profession in the United States. “CCGPP is not writing guidelines, a completely different animal,” he told Chiropractic Economics.

The first in the series of articles — “What is chiropractic’s ‘best practice’ initiative?’ — is written by Ronald J. Farabaugh, DC, a CCGPP board member. That article provides background information on the council and the commission of researchers and is aimed at helping stakeholders understand the process and answers two basic questions:

• “Who are the players?” and

• “What is the difference between a guideline and a best practice?”

The second article, “A Q & A about the best-practice initiative,” answers essential questions that stakeholders may have about CCGPP and the process of developing best practices — including why the initiative is necessary. Lewis is the author of the second paper.

Both papers emphasize the difference between guidelines and best practices, stating that a guideline contains “numbers and/or suggested therapy time frames that are often mistakenly applied as arbitrary limits. A best practice is a process/document that reviews the evidence and provides interpretation consistent with the chiropractic perspective as the providers involved in treating these cases, using chiropractic methods.” The process of developing best practices is ongoing.

In his paper, Lewis states, “CCGPP is placing a special focus on the process of care, identification of risk factors and case complexity, techniques of response monitoring, with benchmarks for intervening when the response is below average.” Philosophy and technique will not be a focus on the initiative.

Lewis also states that CCGPP is not the Mercy Conference revisited. According to chiropractic historian Joseph Keating, PhD, the Mercy Conference guidelines were based upon review of the best available relevant literature (evidence) by panels of chiropractors, who then added their clinical experience to the mix to arrive at consensuses about various clinical assessment and intervention procedures.

Lewis stated that eight out of 82 CCGPP council and commission participants were members of the Mercy Conference commission.

The two papers are available in their entirely at www.ChiroEco.com/ccgpp/ccgpp1.php and www.ChiroEco.com/ccgpp/ccgpp2.php.

Sources: Council on Chiropractic Guidelines and Practice Parameters (CCGPP), http://www.ccgpp.org/.

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